| 降低膝关节多发韧带损伤脱位致残率的分期分型诊治方法和疗效回顾性分析 |
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投稿时间：2020-06-22
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| 作者 | Author | 单位 | Address | E-Mail |
| 李韬 |
LI Tao |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, Huaxi Hospital of Sichuan, Chengdu 610041, Sichuan, China |
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| 熊燕 |
XIONG Yan |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, Huaxi Hospital of Sichuan, Chengdu 610041, Sichuan, China |
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| 张钟 |
ZHANG Zhong |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, Huaxi Hospital of Sichuan, Chengdu 610041, Sichuan, China |
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| 唐新 |
TANG Xin |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, Huaxi Hospital of Sichuan, Chengdu 610041, Sichuan, China |
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| 李箭 |
LI Jian |
四川大学华西医院骨科, 四川 成都 610041 |
Department of Orthopaedics, Huaxi Hospital of Sichuan, Chengdu 610041, Sichuan, China |
hxlijian.china@163.com |
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| 期刊信息：《中国骨伤》2020年，第33卷，第12期，第1134-1141页 |
| DOI：10.12200/j.issn.1003-0034.2020.12.010 |
| 基金项目: |
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中文摘要:目的：探讨依据分期分型诊断进行膝关节多发韧带损伤脱位的个体化修复与重建手术治疗临床疗效。
方法：2018年1月至2019年1月，共收治膝关节多发韧带损伤脱位患者42例。其中男27例，女15例；年龄30~63（47.35±11.90）岁；左膝17例，右膝23例，双膝2例。对所有的膝关节多发韧带损伤脱位患者进行详细的分期分型改良Schenck诊断，其中急性期患者（≤ 3周）23例，陈旧期（>3周）患者19例，脱位Ⅲ型27例，脱位Ⅳ型9例，脱位Ⅵ型6例，并实施相应闭合手法与切开松解复位、韧带直接缝合、锚钉缝合、穿骨缝合等修复方法和各种韧带常规重建等技术治疗，术后采用相应"循序渐激"康复方案。患者术后2、4、6、8周及3、6、9、12个月完成门诊复诊和膝关节功能及稳定性的评估随访，比较术前及术后膝关节稳定性、优良率、致残率和并发症发生率，同时使用国际膝关节评分委员会（International Knee Documentation Committee，IKDC）分级，IKDC主观评分，Lysholm评分，Tegner评分评价膝关节功能。
结果：患者均按期完成门诊复诊及随访，所有患者术后伤口Ⅰ期甲级愈合，4全术后发生下肢静脉血栓，通过术后抗凝治疗并未出现严重的并发症；5例腓总神经损伤通过松解术并进行积极的术后康复神经功能逐渐恢复。术后12个月患肢肌力均达到Ⅴ级，主被动活动度恢复到120°以上；5例前抽屉试验Ⅰ度阳性，2例后抽屉试验Ⅰ度阳性；急性期患者术前IKDC主观评分（20.46±12.61）分，Lysholm（22.58±16.83）分，Tegner（0.71±1.14）分，术后1年IKDC主观评分（69.55±16.57）分，Lysholm（77.73±15.14）分，Tegner（3.14±1.67）分，8例IKDC评级为A级；陈旧期患者，术前IKDC主观评分（39.87±18.52）分，Lysholm（44.22±25.45）分，Tegner（1.87±1.51）分，术后1年IKDC主观评分（67.04±19.07）分，Lysholm（74.87±14.58）分，Tegner（3.06±1.70）分，6例IKDC评级A级。术后1年所有患者膝关功能评分较术前改善（P<0.01）。
结论：膝关节多发韧带损伤脱位依据分期分型采取相对应的手术修复与重建等治疗，术后采取相应的康复方案，术后1年均获得较好的临床疗效，患者满意度高。 |
| 【关键词】膝关节 创伤和损伤 脱位 修复外科手术 |
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| Retrospective analysis on treatment methods and curative effects of reducing the disability rate of multiple ligament injuries and dislocations of the knee joint |
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ABSTRACT Objective: To investigate the clinical effects of individualized repair and reconstruction surgery for multiple ligament injury and dislocation of knee joint based on stage classification diagnosis.
Methods: From January 2018 to January 2019,42 patients with multiple ligament injury and dislocation of the knee joint were treated. There were 27 males and 15 females,aged from 30 to 63 (47.35±11.90) years old,including 17 left knees,23 right knees and 2 bilateral knees. All patients with multiple ligament injuries and dislocations of the knee joint were classified by stages and improved Schenck diagnosis. Among them,23 cases were in acute stage (≤ 3 weeks),19 cases were in old stage (>3 weeks),27 cases were type Ⅲ dislocation and type Ⅳ dislocation. There were 9 cases of dislocation and 6 cases of type Ⅵ dislocation. The corresponding repair methods such as closed manipulation and open release reduction,direct suture of ligament,anchor suture,bone penetrating suture,and routine ligament reconstruction were performed. The corresponding "progressive progressive excitation" rehabilitation program was adopted after the operation. After 2,4,6,8 weeks and 3,6,9,12 months after operation,the outpatient consultation and evaluation of knee joint function and stability were completed. The knee joint stability,excellent and good rate,disability rate and complication rate were compared before and after operation. Internation Knee Documentation Committee(IKDC) grade,IKDC subjective score,Lysholm score and Tegner score were used to evaluate knee joint function.
Results: All patients completed the outpatient follow-up and follow-up on schedule. All patients had gradeⅠwound healing,4 patients had lower extremity venous thrombosis after operation,and there were no serious complications after anticoagulant treatment; 5 patients with common peroneal nerve injury were treated with release surgery and active postoperative rehabilitation,and neurological function gradually recovered. At 12 months after operation,the muscle strength of the affected limb reached grade Ⅴ and the active and passive range of motion recovered to more than 120 degrees. In the acute stage,the IKDC subjective scores were 20.46±12.61,22.58±16.83,0.71±1.14,69.55±16.57,77.73±15.14 and 3.14±1.67,respectively. One year after operation,IKDC subjective score was 67.04±19.07,Lysholm was 74.87±14.58,Tegner was 3.06±1.70,and 6 of them were grade A. After 12 months,the knee function scores of all patients were significantly improved compared with those before operation(P<0.01).
Conclusion: According to the classification of multiple ligament injuries and dislocations of the knee joint,the corresponding surgical repair and reconstruction treatment were adopted,and the corresponding rehabilitation program was adopted after the operation. The patients achieved good clinical treatment effect 12 months after operation,and the patients' satisfaction was high,which improved the excellent and good rate of treatment and reduced the disability rate. |
| KEY WORDS Knee joint Wounds and injuries Dislocations Reconstructive surgical procedures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李韬,熊燕,张钟,唐新,李箭.降低膝关节多发韧带损伤脱位致残率的分期分型诊治方法和疗效回顾性分析[J].中国骨伤,2020,33(12):1134~1141 |
| 英文格式: | LI Tao,XIONG Yan,ZHANG Zhong,TANG Xin,LI Jian.Retrospective analysis on treatment methods and curative effects of reducing the disability rate of multiple ligament injuries and dislocations of the knee joint[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(12):1134~1141 |
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